Kentucky K-4

Enter Personal Information

Full Name:

Social Security Number:

Home Address:

City:

State:

Zip Code:

If SINGLE, and you claim an exemption, enter '1', if you do not, enter '0':

If MARRIED, one exemption each for you and spouse if not claimed on another certificate.:

(a) If you claim both of these exemptions, enter '2'
(b) If you claim one of these exemptions, enter '1'
(c) If you claim neither of these exemptions, enter '0'

 

Exemptions for age and blindness (applicable only to you and your spouse but not to dependents):

(a) If you or your spouse will be 65 years of age or older at the end of the year, and you claim this exemption, enter "4", if both will be 65 or older, and you claim both of these exemptions, enter "8"

(b) If you or your spouse are blind, and you claim this exemption, enter "4"; if both are blind, and you claim both of these exemptions, enter "8"

If you claim exemptions for one or more dependents, enter the number of such exemptions:

National Guard exemption (see instruction 1):

Exemptions for Excess Itemized Deductions (Form K-4A)

Add the number of exemptions which you have claimed above and enter the total:

Additional withholding per pay period under agreement with employer. See instruction 1:

• Signature
• Clear